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Ayala GX, Castro IA, Pickrel JL, Lin SF, Williams CB, Madanat H, Jun HJ, Zive M. A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids' Choice Restaurant Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1494. [PMID: 29194392 PMCID: PMC5750912 DOI: 10.3390/ijerph14121494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023]
Abstract
Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.
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Affiliation(s)
- Guadalupe X Ayala
- Graduate School of Public Health and the Institute for Behavioral and Community Health (IBACH), San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Iana A Castro
- Marketing Department, Fowler College of Business and IBACH, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Julie L Pickrel
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Shih-Fan Lin
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Christine B Williams
- Department of Pediatrics, University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, #0725, La Jolla, CA 92093, USA.
| | - Hala Madanat
- Graduate School of Public Health and the Institute for Behavioral and Community Health (IBACH), San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Hee-Jin Jun
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Michelle Zive
- Department of Pediatrics, University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, #0725, La Jolla, CA 92093, USA.
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Abstract
AbstractOut-of-home foods (takeaway, take-out and fast foods) have become increasingly popular in recent decades and are thought to be a key driver in increasing levels of overweight and obesity due to their unfavourable nutritional content. Individual food choices and eating behaviours are influenced by many interrelated factors which affect the results of nutrition-related public health interventions. While the majority of research based on out-of-home foods comes from Australia, the UK and USA, the same issues (poor dietary habits and increased prevalence of non-communicable disease) are of equal concern for urban centres in developing economies undergoing ‘nutrition transition’ at a global scale. The present narrative review documents key facets, which may influence out-of-home food consumption, drawn from biological, societal, environmental, demographic and psychological spheres. Literature searches were performed and references from relevant papers were used to find supplementary studies. Findings suggest that the strongest determinants of out-of-home food availability are density of food outlets and deprivation within the built environment; however, the association between socio-economic status and out-of-home food consumption has been challenged. In addition, the biological and psychological drives combined with a culture where overweight and obesity are becoming the norm makes it ‘fashionable’ to consume out-of-home food. Other factors, including age group, ethnicity and gender demonstrate contrasting effects and a lack of consensus. It is concluded that further consideration of the determinants of out-of-home food consumption within specific populations is crucial to inform the development of targeted interventions to reduce the impact of out-of-home foods on public health.
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Goffe L, Rushton S, White M, Adamson A, Adams J. Relationship between mean daily energy intake and frequency of consumption of out-of-home meals in the UK National Diet and Nutrition Survey. Int J Behav Nutr Phys Act 2017; 14:131. [PMID: 28938893 PMCID: PMC5610411 DOI: 10.1186/s12966-017-0589-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/19/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Out-of-home meals have been characterised as delivering excessively large portions that can lead to high energy intake. Regular consumption is linked to weight gain and diet related diseases. Consumption of out-of-home meals is associated with socio-demographic and anthropometric factors, but the relationship between habitual consumption of such meals and mean daily energy intake has not been studied in both adults and children in the UK. METHODS We analysed adult and child data from waves 1-4 of the UK National Diet and Nutrition Survey using generalized linear modelling. We investigated whether individuals who report a higher habitual consumption of meals out in a restaurant or café, or takeaway meals at home had a higher mean daily energy intake, as estimated by a four-day food diary, whilst adjusting for key socio-demographic and anthropometric variables. RESULTS Adults who ate meals out at least weekly had a higher mean daily energy intake consuming 75-104 kcal more per day than those who ate these meals rarely. The equivalent figures for takeaway meals at home were 63-87 kcal. There was no association between energy intake and frequency of consumption of meals out in children. Children who ate takeaway meals at home at least weekly consumed 55-168 kcal more per day than those who ate these meals rarely. Additionally, in children, there was an interaction with socio-economic position, where greater frequency of consumption of takeaway meals was associated with higher mean daily energy intake in those from less affluent households than those from more affluent households. CONCLUSIONS Higher habitual consumption of out-of-home meals is associated with greater mean daily energy intake in the UK. More frequent takeaway meal consumption in adults and children is associated with greater daily energy intake and this effect is greater in children from less affluent households. Interventions seeking to reduce energy content through reformulation or reduction of portion sizes in restaurants, cafés and takeaways could potentially lead to reductions in mean daily energy intake, and may reduce inequalities in health in children.
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Affiliation(s)
- Louis Goffe
- Institute of Health & Society, Newcastle University, Newcastle, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle, UK
| | - Stephen Rushton
- School of Natural and Environmental Sciences, Newcastle University, Newcastle, UK
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle, UK
- Centre for Diet and Activity Research, (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ashley Adamson
- Institute of Health & Society, Newcastle University, Newcastle, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle, UK
| | - Jean Adams
- Centre for Diet and Activity Research, (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Kraak VI, Englund T, Misyak S, Serrano EL. A novel marketing mix and choice architecture framework to nudge restaurant customers toward healthy food environments to reduce obesity in the United States. Obes Rev 2017; 18:852-868. [PMID: 28560794 DOI: 10.1111/obr.12553] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/19/2023]
Abstract
This review identified and adapted choice architecture frameworks to develop a novel framework that restaurant owners could use to promote healthy food environments for customers who currently overconsume products high in fat, sugar and sodium that increase their risk of obesity and diet-related non-communicable diseases. This review was conducted in three steps and presented as a narrative summary to demonstrate a proof of concept. Step 1 was a systematic review of nudge or choice architecture frameworks used to categorize strategies that cue healthy behaviours in microenvironments. We searched nine electronic databases between January 2000 and December 2016 and identified 1,244 records. Inclusion criteria led to the selection of five choice architecture frameworks, of which three were adapted and combined with marketing mix principles to highlight eight strategies (i.e. place, profile, portion, pricing, promotion, healthy default picks, prompting or priming and proximity). Step 2 involved conducting a comprehensive evidence review between January 2006 and December 2016 to identify U.S. recommendations for the restaurant sector organized by strategy. Step 3 entailed developing 12 performance metrics for the eight strategies. This framework should be tested to determine its value to assist restaurant owners to promote and socially normalize healthy food environments to reduce obesity and non-communicable diseases.
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Affiliation(s)
- V I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - T Englund
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, USA
| | - S Misyak
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - E L Serrano
- Virginia Cooperative Extension's Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Hillier-Brown FC, Summerbell CD, Moore HJ, Routen A, Lake AA, Adams J, White M, Araujo-Soares V, Abraham C, Adamson AJ, Brown TJ. The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review. Obes Rev 2017; 18:227-246. [PMID: 27899007 PMCID: PMC5244662 DOI: 10.1111/obr.12479] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Ready-to-eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions. METHODS Studies of any design and duration that included any consumer-level or food-outlet-level before-and-after data were included. RESULTS Thirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre-packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer-level outcomes. More 'intrusive' interventions that restricted or guided choice generally showed a positive impact on food-outlet-level and customer-level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact. CONCLUSION Interventions to promote healthier ready-to-eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.
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Affiliation(s)
- F C Hillier-Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C D Summerbell
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - H J Moore
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - A Routen
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A A Lake
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Centre for Public Policy & Health, School of Medicine, Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - J Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - V Araujo-Soares
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - C Abraham
- Psychology Applied to Heath, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - A J Adamson
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK
| | - T J Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Capewell S, Lloyd-Williams F. Promotion of healthy food and beverage purchases: are subsidies and consumer education sufficient? LANCET PUBLIC HEALTH 2017; 2:e59-e60. [PMID: 29253392 DOI: 10.1016/s2468-2667(17)30012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK.
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
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Hillier-Brown FC, Summerbell CD, Moore HJ, Wrieden WL, Adams J, Abraham C, Adamson A, Araújo-Soares V, White M, Lake AA. A description of interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England: a systematic mapping and evidence synthesis. BMC Public Health 2017; 17:93. [PMID: 28103846 PMCID: PMC5244522 DOI: 10.1186/s12889-016-3980-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ready-to-eat meals (to eat in, to take away or to be delivered) sold by food outlets are often more energy dense and nutrient poor compared with meals prepared at home, making them a reasonable target for public health intervention. The aim of the research presented in this paper was to systematically identify and describe interventions to promote healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England. METHODS A systematic search and sift of the literature, followed by evidence mapping of relevant interventions, was conducted. Food outlets were included if they were located in England, were openly accessible to the public and, as their main business, sold ready-to-eat meals. Academic databases and grey literature were searched. Also, local authorities in England, topic experts, and key health professionals and workers were contacted. Two tiers of evidence synthesis took place: type, content and delivery of each intervention were summarised (Tier 1) and for those interventions that had been evaluated, a narrative synthesis was conducted (Tier 2). RESULTS A total of 75 interventions were identified, the most popular being awards. Businesses were more likely to engage with cost neutral interventions which offered imperceptible changes to price, palatability and portion size. Few interventions involved working upstream with suppliers of food, the generation of customer demand, the exploration of competition effects, and/or reducing portion sizes. Evaluations of interventions were generally limited in scope and of low methodological quality, and many were simple assessments of acceptability. CONCLUSIONS Many interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England are taking place; award-type interventions are the most common. Proprietors of food outlets in England that, as their main business, sell ready-to-eat meals, can be engaged in implementing interventions to promote healthier ready-to-eat-food. These proprietors are generally positive about such interventions, particularly when they are cost neutral and use a health by stealth approach.
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Affiliation(s)
- Frances C. Hillier-Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Durham, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
| | - Carolyn D. Summerbell
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Durham, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
| | - Helen J. Moore
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Durham, UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
| | - Wendy L. Wrieden
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
- Present address: CEDAR – UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charles Abraham
- Psychology Applied to Heath, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ashley Adamson
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Vera Araújo-Soares
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
- Present address: CEDAR – UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Amelia A. Lake
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle-upon-Tyne, UK
- Centre for Public Policy & Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Durham, UK
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